Laryngo-rhino-otologie最新文献

Unlike Swedish snus, nicotine pouches do not contain tobacco. Nicotine pouches are placed under the upper lip so that nicotine and other ingredients can be absorbed through the oral mucosa. Since 2021, they have been subject to the Foodstuffs Act in Germany and are not marketable due to their high nicotine content. The prevalence of nicotine pouch use in children and adolescents is being investigated.As part of the "Prevention Radar" observational study, a random sample of 12,655 pupils in grades 5 to 10 from 14 federal states were recruited to answer a questionnaire in the 2022/2023 school year. The average age was 13.2 years (SD=1.72). The gender ratio was balanced (49% girls). The primary endpoint of the cross-sectional study was the lifetime prevalence of nicotine pouch use.The lifetime prevalence of nicotine pouch use in the total sample was 5.4% [95% CI 4.9-5.8]. Use was more common among boys (6.3% [95% CI 5.6-6.9]) than girls (3.5% [95% CI 3.0-4.0]) and increased with age. At the age of 16/17 years, 15.2% [95% CI 12.3-18.7] of boys and 10.3% [95% CI 7.8-13.6] of girls had used nicotine pouches. Consumption covaried positively with sensation seeking, negatively with subjective social status and occurred less frequently in grammar schools. Almost all children and adolescents with consumption experience had also smoked other nicotine products (e-cigarettes, tobacco cigarettes and water pipes).Although not marketable, one in seven male pupils and one in ten female pupils aged 16/17 had used nicotine pouches at least once.

The incidence of cervical squamous cell carcinoma (SCC)-CUP is increasing, with a significant proportion being HPV-associated. In this 10-year retrospective study, we analyzed clinical and therapeutic parameters of patients with cervical SCC-CUP. Primary tumor detection rates in patients with initial SCC-CUP (SCC-CUP_init) were assessed and mean overall survival and disease-free survival of patients without primary tumor detection after an extended diagnostic workup, i.e. definitive SCC-CUP (SCC-CUP_def), were analyzed taking p16-status into account to derive therapeutic recommendations.85% (n=131/155) of patients with CUP_init, presented with SCC followed by adenocarcinoma metastases in 7% (n=10/155). In 41% (n=54/131) of patients with SCC-CUP_init, a primary tumor was identified after an extended diagnostic workup; the primary tumor detection rate was significantly higher in p16-positive compared to p16-negative cases (63% vs. 23%, p<0,001). PET imaging specificity was 73% for both sensitivity and specificity. SCC-CUP_def were primarily treated surgically with adjuvant radio(chemo)therapy. SCC-CUP_def patients with positive vs. negative p16-status had significantly longer overall survival (53 vs. 41 Monate, p=0,037), as well as patients with cN1- vs. cN3-status and M0- vs. M1-status.p16-status influences diagnosis and therapy response in patients with SCC-CUP: in p16-positive SCC-CUP_init, primary tumor detection rates were significantly higher than in p16-negative SCC-CUP_init. In patients with SCC-CUP_def, p16-positivity was associated with improved overall survival, albeit to an extent which does not justify therapy de-escalation.

Augmented Reality (AR) is an emerging technology that supports surgeons in spatial reasoning during clinical procedures. The most fascinating applications include visualizations of anatomical structures, cross-sectional images or surgical approaches, which can be displayed directly on the patient in combination with the real world. The aim of this narrative review is to outline the state of the art and future directions of AR in head and neck surgery. Particular attention is paid to explaining the potential and the difficulties that still need to be solved with this new technology.

Background: Due to heterogeneous data, the indication for elective neck dissection (END) in patients with squamous cell carcinoma of the hypopharynx and oropharynx (HPSCC and OPSCC) in stages T1/2N0 is somewhat unclear. Therefore, in this multicenter study, we performed detailed analysis of the metastatic behavior of HPSCC and OPSCC.

Material and methods: The nodal metastatic patterns of 262 HPSCC and OPSCC patients who had undergone surgery was retrospectively investigated. In addition, recurrence-free and overall survival were recorded. Furthermore, a systematic literature review on the topic was completed.

Results: In patients with HPSCC, a discrepancy between clinical and pathologic N status was recorded in 62.1% of patients vs. 52.4% for p16- OPSCC, and 43.6% for p16+ OPSCC. The occult metastasis rate in cT1/2cN0 primary tumors was 38.9% for HPSCC vs. 17.8% (p16- OPSCC) and 11.1% (p16+ OPSCC). Contralateral metastases occurred in 22.2% of cases for HPSCC at stages cT1/2cN0, compared to only 9.1% for p16- OPSCC, and 0% for p16+ OPSCC patients.Patients with p16+ OPSCC had better recurrence-free and overall survival than p16- OPSCC and HPSCC patients. A direct association between patient survival and the extent of neck surgical therapy could not be demonstrated in our patients.

Conclusion: Patients with HPSCC are at risk for bilateral neck metastases from stage cT1/2cN0, justifying bilateral END. Patients with T1/2 OPSCC present with occult metastases ipsilaterally in >20% of cases; however, the risk for contralateral occult metastasis is <10%. Hence, in strictly lateralized cT1/2CN0 tumors, omission of contralateral END may be considered.